WASHINGTON -- Patients given high doses of a steroid during heart surgery were less likely to need blood products, researchers said here.

Action Points

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Explain that a substudy of a randomized clinical trial found a decrease in the need for autologous blood transfusion during surgery for patients undergoing CABG who received dexamethasone in a single high-dose during surgery compared with placebo.

Note that ICU red cell transfusions and transfusions of other blood products during surgery or postoperatively in the ICU did not differ for dexamethasone or placebo recipients.

WASHINGTON – Patients given high doses of a steroid during heart surgery were less likely to need blood products, researchers said here.

In a post-hoc substudy of a randomized controlled trial, significantly more patients who were given dexamethasone 1 mg/kg during coronary artery bypass (CABG) surgery did not receive transfusions (61% versus 57.9%, P=0.03), according to Jan Dieleman, MD, of University Medical Center Utrecht in the Netherlands, and colleagues.

"We think this could be a good way to reduce blood transfusions," Dieleman said during a presentation at the American Society of Anesthesiologists meeting. "It seems to be cost-effective because dexamethasone costs nothing."

Corticosteroids are sometimes given during cardiac surgery to dampen the inflammatory response, with the intention of reducing the need for intravenous fluid therapy -- including autologous blood products -- and vasopressor and inotropic therapy after the procedure.

To assess whether a high dose of corticosteroids could cut the number of blood transfusions, Dieleman and colleagues conducted a post-hoc substudy of the DECS study of dexamethasone's effect on major adverse outcomes.

The original multicenter, randomized, double-blind study – the results of which are slated for publication in the Journal of the American Medical Association -- enrolled 4,494 adults having CABG surgery between 2006 and 2011.

Of those patients, 2,235 had a single dose of dexamethasone after induction of anesthesia, while 2,247 received placebo.

Dieleman and colleagues specifically looked at the proportion of patients who did not receive a transfusion of any blood products after their surgery. They also looked at reductions in packed red blood cells, fresh frozen plasma, or thrombocytes, both in the operating room and subsequently in the ICU.

They found that 61% of patients who had been given the steroid had no blood transfusions, compared with 57.9% in the placebo group (P=0.03).

Fewer patients in the dexamethasone group received packed red blood cells in the operating room (83.9% versus 80.8% , P<0.01), but there were no differences in this metric in the ICU, they reported.

Thus, the effects were mainly due to fewer transfusions of red blood cells during the operation itself, Dieleman said.

There were no significant differences in transfusion rates of the other types of blood products in the operating room or in the ICU, they added.

Still, Dieleman concluded that using high-dose dexamethasone during cardiac surgery costs little and is largely safe, making it a reasonable prophylactic intervention to decrease the need for blood product transfusions.

Isaac George, MD, a cardiothoracic surgeon at Columbia University Medical Center in New York who wasn't involved in the study, told MedPage Today the trial looks at "an important clinical endpoint, as inflammation after an operation can complicate the postoperative hospital course by causing pain, fever, adhesions, vasodilatation, and can mimic ischemia."

However, he said he would be concerned that high-dose steroids would slow wound healing, increase blood glucose, and increase infections.

"This is a real issue, especially in this era of surgery on elderly patients ... [who] are already at high risk for impaired wound healing," George said. "Steroids that are not clinically indicated may have real long-term and short-term effects on sternal healing."

Older patients may not be able to tolerate steroids from a gastrointestinal standpoint, he said, "and these risks are exacerbated during CPB."

Also, there are "very good data that systemic clinical algorithms to reduce blood use in cardiac surgery, i.e. blood conservation therapy, works well," George told MedPage Today. "Incorporating these algorithms in a safe, concerted manner may have a more meaningful reduction in blood use without the risks associated with steroids."

He said further trials may want to assess the effects of lower dose steroids in this setting.

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